Provider Demographics
NPI:1073562302
Name:OFOEYENO, FELICIA ADEBUKONLA
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ADEBUKONLA
Last Name:OFOEYENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-0833
Mailing Address - Country:US
Mailing Address - Phone:832-955-4632
Mailing Address - Fax:
Practice Address - Street 1:19807 COREYBEND CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3788
Practice Address - Country:US
Practice Address - Phone:832-955-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist